The Usefulness of Endoscopic Management in Benign Sinonasal Tumors

BACKGROUND AND OBJECTIVES: There are increasing evidence suggesting that the endoscopic approach can be used successfully for the treatment of benign sinonasal tumors. In the present study, we reviewed a 12-year experience of our institution for endoscopic management of benign sinonasal tumors. MATERIALS AND METHODS: We retrospectively reviewed the medical records and radiologic findings of 185 patients who underwent endonasal endoscopic resection of benign sinonasal tumors at the Catholic Medical Center between 1996 and 2007. RESULT: Inverted papilloma (119 cases, 64.3%) was most common, followed by hemangioma (14 cases), pyogenic granuloma (11 cases), angiofibroma (9 cases), and osteoma (7 cases). The most common symptom was nasal obstruction (70.8%). Sixteen cases (8.6%) recurred after endoscopic resection (12 cases of inverted papilloma, 2 cases of ossifying fibroma, and 2 cases of fibrous dysplasia). No major complications were reported. CONCLUSION: Endoscopic approach allows for successful surgical outcomes and good cosmetic effects among patients with benign sinonasal tumors. We suggest that, in selected cases, benign tumors involving the sinonasal tract can be safely and radically removed using the endoscopic technique.

Clinical Characteristics of Inflammtory Pseudotumor of the Orbit / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Inflammatory pseudotumor is not malignant, but similar to malignancy lesions with respect to its clinical and radiological manifestations. It is well-known to opthalmologists and neurosurgeons, but unfamiliar to otolaryngologists. The objective of this study is to determine the diagnosis and treatment of inflammatory pseudotumor of the orbit. SUBJECTS AND METHOD: We reviewed 17 patients who visited Kangnam St. Mary's hospital and were diagnosed with inflammatory pseudotumor with clinical manifestations and radiological studies between September, 1994 and December, 2006. RESULTS: Seventeen patients were treated with high dose steroid, and of these, 12 showed clinical improvement, although 7 of these patients later showed recurrence. Of the five patients who initially showed no clinical improvement, one received radiation therapy but did not show improvement whereas two patients showed no improvement. One patient's symptoms improved after surgical decompression. CONCLUSION: Our study suggests that the initial treatment of inflammatory pseudotumor should be high dose steroid treatment without improvement and the second treatment should be radiation therapy or surgical treatment.

A Case of Congenital Inner Ear Anomaly Combined with Cerebrospinal Leak Using Hydroxyapatite Cement for Treatment / 대한이비인후과학회지

Cerebrospinal fluid otorrhea is a rare disease entity, especially when brought on by spontaneous causes. The site of leakage should be identified to treat the disorder effectively. Various localizing modality was suggested in the literatures. Intrathecal gadolinium-enhanced magnetic resonance imaging identifies the small leakage site easily and correctly. Hydroxyapatite cement is a calcium phosphate-based material that forms dense paste mixed with water or sodium phosphate solution. Hydroxyapatite cement is remarkable for its excellent biocompatability in interacting with the native bone to osseointergrate with the surrounding bone. We report on our experience of successfully treating a patient with the cerebrospinal fluid leak from the congenital inner ear anomaly using the hydroxyapatite cement.

Hyperacusis in Patients with Tinnitus-Audiometrical Evaluation & Clinical Characterization / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hyperacusis, defined as increased sound sensitivity or decreased sound tolerence, has been reported to be related to tinnitus. The purposes of this study are to investigate the audiometrical characterization of hyperacusis and to evaluate the possible effect of hyperacusis on clinical presentation in tinnitus patients. MATERIALS AND METHOD: A total of 128 tinnitus patients, who visited the Tinnitus Clinic, Kangnam St. Mary's Hospital from May, 1999 to September, 2000, were included in this study. Their audiometrical study results were analyzed, and their hearing impairment was compared with those of normal controls. RESULTS: The prevalence of hyperacusis in the patients with tinnitus were as high as 37.8% according to the questionnare. Uncomfortable loudness levels to pure tone stimuli was significantly low in hyperacusis patients. In the tinnitus patients with normal hearing, the tinnitus handicap scores between hyperacusis and non-hyperacusis patients were significantly different, though the results of tinnitogram showed no difference. CONCLUSION: The hyperacusis test using pure tone stimuli may screen hyperacusic patients. It is necessary to consider the presence of hyperacusis in tinnitus patients so as to understand patient discomfort and to seek appropriate treatment modality.

Detection of Human Papillomavirus and Epstein-Barr Virus in Sinonasal Inverted Papillomas and Its Correlation with p53 and Proliferating Cell Nuclear Antigen Expression / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sinonasal inverted papillomas are benign but topographically aggressive neoplasms that have a high recurrence rate and seem to be associated with malignancy. The etiology of inverted papilloma remains unknown, but some hypotheses suggest that nasal polyps proliferation and chronic inflammation are due to allergy or various infectious lesions. This study was to elucidate the biological characteristics and the role of human papillomavirus (HPV) and Ebstein -Barr virus (EBV) and the expression of p53 protein and proliferating cell nuclear antigen (PCNA) in sinonasal inverted papillomas. MATERIALS AND METHODS: We examined 26 specimens from 26 individuals with normal nasal mucosae (n=10) and inverted papillomas (n=16) to determine the occurance of HPV and EBV infection and the expression of p53 protein and PCNA. RESULTS: Of the 16 Inverted papillomas, HPV DNA was detected in eight cases, HPV 18 was detected in two cases (18%), HPV 16 and HPV 33 were both found in every case (6%), HPV 6 and HPV 16 were coinfected in one case (6%), and other types were found in 3 cases. HPV DNA was not detected in the normal nasal mucosae. EBV DNA was detected in 10 cases (62%) out of 16 inverted papillomas ancl in two cases (20%) of 10 normal nasal mocosae. The altered p53 protein expression was observed in four cases (25%), and positive PCNA staining was detected in four cases (25%) out of 16 inverted papillomas. One positive PCNA staining was detected among 10 normal mucosae. The mean PC10 index was 16.0% in the inverted papillomas group and 4.1% in normal nasal mucosae group. CONCLUSION: An inverse correlation may exist between oncogenic HPV infection and p53 alteration in sinonasa1 inverted papillomas.

Evaluation of the Swallowing after Supracricoid Partial Laryngectomy with Modified Barium Swallow / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Supracricoid partial laryngectomy is popular due to its satisfactory oncological and functional outcomes in selected laryngeal cancers. Their postoperative management is now well codified, but functional failures still persist. The aims of this study were to analyze the deglutition modification induced by these intervention and to plan a better rehabilitation program of swallowing. MATERIALS AND METHOD: For the evaluation of swallowing function, the swallowing analysis was performed by following the videofluoroscopic evaluation using the modified barium swallow (Logemann, 1983) in 14 laryngeal cancer patients. RESULTS: Asymptomatic aspiration was observed in 4 patients (28.6%), especially in patients with the extended procedures (p=0.032) and delayed decannulation (p=0.035). Aspiration was associated with faulty backward tilting of epiglottis and inadequate movement of the base of tongue (p<0.05). CONCLUSIONS: In planning the swallowing rehabilitation program after supracricoid partial laryngectomy, recuperation of proper epiglottic movement, which is promoted by exercise of backward tongue movement, is the most important concern.